目的 評(píng)價(jià)卡泊芬凈聯(lián)合萬(wàn)古霉素治療腎移植術(shù)后肺部感染患者的療效。方法 選取西安交通大學(xué)第一附屬醫(yī)院2018年8月-2019年10月收治的腎移植術(shù)后肺部感染患者122例為研究對(duì)象，按照隨機(jī)數(shù)表法將患者分為對(duì)照組和觀察組，每組各61例。對(duì)照組患者靜脈滴注注射用鹽酸去甲萬(wàn)古霉素，250 mg/次，采用0.9%氯化鈉注射液250 mL溶解，滴注時(shí)間>1 h，12 h/次。用藥3 d后，根據(jù)血藥濃度谷峰值調(diào)整給藥劑量。觀察組患者在對(duì)照組的基礎(chǔ)上靜脈滴注注射用醋酸卡泊芬凈，首次給藥劑量為70 mg，使用200 mL葡萄糖溶液溶解，第2天開(kāi)始以維持劑量為50 mg治療，1次/d。兩組療程均為14 d。觀察兩組患者的臨床療效，比較兩組治療前后的腎功能指標(biāo)、肺功能指標(biāo)及血?dú)庵笜?biāo)水平。結(jié)果 治療后，觀察組治療后總有效率為91.80%，顯著高于對(duì)照組的77.05%，兩組總有效率比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，觀察組細(xì)菌完全清除率為34.43%，顯著高于對(duì)照組的14.75%，兩組細(xì)菌完全清除率比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者治療后尿微量白蛋白/肌酐比值（ACR）、血肌酐（Scr）、尿β2-微球蛋白均顯著升高（P<0.05），組間比較觀差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者治療后肺功能指標(biāo)第1秒用力呼氣容積用力呼氣容積（FEV₁）、第1秒用力呼氣容積占預(yù)計(jì)值百分比（FEV₁% pred）和FEV₁/FVC均顯著升高（P<0.05），治療后，觀察組肺功能指標(biāo)水平顯著高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者的動(dòng)脈血氧飽和度（SaO₂）、動(dòng)脈血氧分壓（pO₂）和氧合指數(shù)（OI）均顯著升高，動(dòng)脈血二氧化碳分壓（pCO₂）顯著降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，觀察組患者的SaO₂、pO₂、OI顯著高于對(duì)照組，pCO₂明顯低于對(duì)照組（P<0.05）。結(jié)論 卡泊芬凈聯(lián)合萬(wàn)古霉素治療腎移植術(shù)后肺部感染具有可靠的應(yīng)用價(jià)值，能夠有效抑制患者肺部感染，卡泊芬凈與萬(wàn)古霉素聯(lián)合應(yīng)用起效迅速，但仍需根據(jù)患者實(shí)際情況合理選擇用藥。

Objective To evaluate the efficacy of caspofungin combined with vancomycin in treatment of pulmonary infection after renal transplantation. Methods A total of 122 patients with pulmonary infection after renal transplantation admitted to the First Affiliated Hospital of Xi'an Jiaotong University from August 2018 to October 2019 were selected as study subjects. According to the random number table method, the patients were divided into control group and observation group, with 61 patients in each group. Patients in the control group were iv administered with Norvancomycin Hydrochloride for Injection, 250 mg/time, dissolved in 0.9% sodium chloride injection 250 mL, and the infusion time was less than 1 h, 12 h/time. After 3 days, the dose was adjusted according to the peak value of blood concentration. Patients in the observation group were iv administered with Caspofungin Acetate for Injection on the basis of the control group, the first dose was 70 mg, and 200 mL glucose solution was used for dissolution. The maintenance dose was 50 mg at the beginning of the second day, once daily. The course of treatment in both groups was 14 days. The clinical efficacy of two groups was observed, and the renal function index, lung function index, and blood gas index level before and after treatment were compared. Results After treatment, the total effective rate of the observation group was 91.80%, which was significantly higher than 77.05% of the control group, and the difference between two groups was statistically significant (P<0.05). After treatment, the bacterial clearance rate of the observation group was 34.43%, which was significantly higher than 14.75% of the control group, and the difference between two groups was statistically significant (P<0.05). After treatment, ACR, Scr and urine β2-microglobulin were significantly increased in two groups (P<0.05), and there was no statistically significant difference between two groups. After treatment, lung function indexes of FEV₁, FEV₁%pred, and FEV₁/FVC were significantly increased in two groups (P<0.05). After treatment, lung function indexes in the observation group were significantly higher than those in the control group, with statistically significant differences (P<0.05). After treatment, SaO₂, pO₂ and OI in two groups were significantly increased, but pCO₂ was significantly decreased (P<0.05), the difference between two groups before and after treatment was statistically significant (P<0.05). After treatment, SaO₂, pO₂ and OI in the observation group were significantly higher than those in the control group, and pCO₂ was significantly lower than that in the control group (P<0.05). Conclusion The combination of caspofungin combined with vancomycin has reliable application value in treatment of pulmonary infection after renal transplantation, which can effectively inhibit the pulmonary infection of patients. The combination of caspofungin combined with vancomycin has a rapid effect, but it still needs to be rationally selected according to the actual situation of patients.

R978.1

國(guó)家自然科學(xué)基金資助項(xiàng)目（81771485，81971290）；陜西省創(chuàng)新人才推進(jìn)計(jì)劃—青年科技新星項(xiàng)目（2019KJXX-046）；陜西省重點(diǎn)研發(fā)計(jì)劃項(xiàng)目（2020SF-136）；西安交通大學(xué)第一附屬醫(yī)院臨床研究中心面上項(xiàng)目（XJTU1AF-CRF-2017-012）；校級(jí)中央高校基本科研業(yè)務(wù)費(fèi)（xjj2018262）